OBJECTIVES: To determine whether maternal supplementation with high-dose docosahexaenoic acid (DHA) in breastfed, very preterm neonates improves neurodevelopmental outcomes at 18 to 22 months’ corrected age (CA). METHODS: Planned follow-up of a randomized, double-blind, placebo-controlled, multicenter trial to compare neurodevelopmental outcomes in breastfed, preterm neonates born before 29 weeks’ gestational age (GA). Lactating mothers were randomized to receive either DHA-rich algae oil or a placebo within 72 hours of delivery until 36 weeks’ postmenstrual age. Neurodevelopmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development third edition (Bayley-III) at 18 to 22 months’ CA. Planned subgroup analyses were conducted for GA (<27 vs ≥27 weeks’ gestation) and sex. RESULTS: Among the 528 children enrolled, 457 (86.6%) had outcomes available at 18 to 22 months’ CA (DHA, N = 234, placebo, N = 223). The mean differences in Bayley-III between children in the DHA and placebo groups were −0.07 (95% confidence interval [CI] −3.23 to 3.10, P = .97) for cognitive score, 2.36 (95% CI −1.14 to 5.87, P = .19) for language score, and 1.10 (95% CI −2.01 to 4.20, P = .49) for motor score. The association between treatment and the Bayley-III language score was modified by GA at birth (interaction P = .07). Neonates born <27 weeks’ gestation exposed to DHA performed better on the Bayley-III language score, compared with the placebo group (mean difference 5.06, 95% CI 0.08–10.03, P = .05). There was no interaction between treatment group and sex. CONCLUSIONS: Maternal DHA supplementation did not improve neurodevelopmental outcomes at 18 to 22 months’ CA in breastfed, preterm neonates, but subgroup analyses suggested a potential benefit for language in preterm neonates born before 27 weeks’ GA.

Background: The identification of factors involved in the postnatal growth of preterm infants will help achieve growth similar to that of term infants. Objectives: As per protocol: to compare body composition in very preterm infants at term-corrected age (TCA) with that in term infants, and to explore relationships between neonatal characteristics and body composition in preterm infants. Methods: Anthropometry, nutritional characteristics, and neonatal outcomes were prospectively collected in 26 preterm (<29 weeks) and 33 term (37-40 weeks) infants. Body composition using dual-energy X-ray absorptiometry (DXA) was measured at TCA in preterm infants and between days 7 and 10 in term infants. Results: Parenteral nutrition in preterm infants provided a mean of 2.9 ± 0.2 and 2.1 ± 0.5 g/kg/day of intravenous amino acids and lipids, respectively, during the first week of life. The mean weight gain velocity from birth to DXA assessment was 12.1 ± 1.4 g/kg/day. Compared with term infants, preterm infants at TCA were shorter and lighter, with a smaller head circumference, a lower weight estimated by DXA (2,960 ± 552 vs. 3,843 ± 377 g), and increased skinfold thicknesses. Fat mass percent (13.9 ± 5.4%) and lean mass percent (84.7 ± 5.6%) in preterm infants were similar to those in term infants (14.7 ± 3.5 and 83.5 ± 3.6%, respectively). Neonatal weight gain velocity in preterm infants was positively associated with lean mass (grams). Conclusion: Subcutaneous fat is increased in preterm infants. Higher protein intake in preterm infants might increase weight gain velocity and achieve a lean mass comparable to that of term infants.

Exercise intensity modulates neonatal body composition. The long-term significance of a reduced BW, adiposity and BMC with VPA requires further study.